Leavitt may be signal on exchanges

The selection of Mike Leavitt to lead Mitt Romney’s transition team doesn’t mean the Affordable Care Act’s health insurance exchanges are here to stay. But it is a reminder of how some Republicans, regardless of the ACA, have already been circling behind the exchange concept.

It also gives the health care world an idea of how exchanges could look under a Romney administration. In all likelihood, they’d be portals — the way Leavitt’s home state of Utah did them — and not much like the more active marketplaces of the Affordable Care Act.

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News over the weekend of Leavitt’s involvement in a would-be Romney administration sent some on the right into near apoplectic shock that Romney would pick someone who’s profiting from ACA implementation. Leavitt’s firm is making millions advising states on how to design exchanges, the ACA’s state-based marketplaces that will deliver federal subsidies to purchase insurance and enable about half of the law’s coverage expansion.

But a President Romney would obviously still be the guy calling the shots, and of course he’s repeatedly stressed his dedication to blowing up the health care law on Day One and starting from scratch. His campaign again made that much clear following some weekend chatter over Leavitt’s role.

If a Romney replacement plan does surface, though, it’s possible that exchanges — an idea that has Republican roots — could be in the mix of options. And if exchanges were to be resurrected, they wouldn’t look very much like those in President Barack Obama’s health care law, if Leavitt’s and Romney’s own history with exchanges is any indication.

What’s more, that would be welcome news to some red states that for some time have liked the exchange concept but not its association with “Obamacare” or the prescribed requirements now coming almost weekly from Washington.

“Exchanges are going to be part of the future no matter what,” Leavitt told POLITICO in February. “The Affordable Care Act didn’t invent the exchange — we’ve been trying since the ’70s to get the small and individual group markets to buy insurance like a larger group. That has always been the problem, and the exchange will always be the solution.”

So what would a Romney/Leavitt exchange look like? Think “Utah” much more than “Massachusetts.”

In the same POLITICO interview, Leavitt said he would encourage states to pursue “free market” exchanges, like the one created in his home state of Utah, as a way for states to move forward.